Key Leadership Role
We are seeking a seasoned professional to oversee initiatives that reduce non-compliant hospital benefit outlay through strategic claims leakage prevention.
* This key leadership role involves managing the end-to-end onsite and desktop auditing process, assisting with compliance monitoring, and optimizing system controls to ensure effective cost management and contract integrity.
A strong, proactive leader who can create a positive culture and drive measurable results is required for this position.
The ideal candidate will have:
* Tertiary qualifications in relevant areas (nursing, health information management, clinical coding, management etc) or equivalent experience.
* Prior experience in a clinical setting, preferably with a background in Special Care Nursery (SCN) or Intensive Care Unit (ICU).
* Audit experience in health insurance or hospital environment.
* Proven experience in successfully leading small teams to achieve strong KPIs.
* An understanding of Hospital Casemix Protocol (HCP) data submission process.
* An understanding of Hospital Purchaser Provider Agreement contracts, Clinical Coding, Medicare Benefit Schedule, and relationship of these to hospital claims.
* Experience in a major private or public hospital with significant exposure to operating theatre (various specialities) and/or ICU areas.
* The ability to recognize trends, insights, and patterns using complex data sets and reports.
Key Responsibilities
* Leading and mentoring a team of clinical coders and health information managers to deliver high-quality, impactful audit results.
* Developing plans or programmes of both onsite and desktop Clinical and DRG audits under direction.
* Assisting in the preparation and completion of onsite provider audits.
* Managing and monitoring end-to-end processes including follow-up and financial management of incorrect billing.
* Providing analysis and/or reporting of non-compliant billing trends and escalating to stakeholders as required.
* Providing clinical advice on statistical reports produced by Data Scientists and Claims Analysts to determine further investigation and action.
* Initiating and developing relevant data reports to identify areas of actual and potential claims leakage.
Benefits
This is a permanent role with hybrid work arrangements, allowing flexibility to work from home when not visiting sites or working from the office.
Regular interstate travel may be required.
Why Work Here
A career at our organization offers the opportunity to make a real difference in the lives of our customers and communities.
Our purpose is to help people live longer, healthier, happier lives and make a better world.
We're a 'health and care' company providing more wide-ranging services to benefit people's health and wellbeing.
Join us to contribute your expertise and passion to shaping a brighter future.